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Published on: June 8, 2022
Renal function deterioration is an independent mortality determinant in Koreans diagnosed with lupus nephritis
Howook Jeon1, Jennifer Lee2, Ji Hyeon Ju2
1Division of Rheumatology, Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, 37128The Catholic University of Korea, Uijeongbu-si, Republic of Korea.
Insights
Deteriorating kidney function is a key predictor of death in lupus nephritis patients. Systemic lupus erythematosus (SLE) flares also contribute to mortality, especially in those with end-stage renal disease.
Area of Science:
- Nephrology
- Immunology
- Public Health
Background:
- Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE).
- Predicting mortality in LN patients based on renal function is crucial for clinical management.
- Understanding causes of death is essential for improving patient outcomes.
Purpose of the Study:
- To identify predictors of mortality and causes of death in Korean patients with lupus nephritis.
- To analyze the impact of final renal function on mortality rates in LN.
- To investigate the role of SLE flares and kidney transplantation in LN patient survival.
Main Methods:
- Retrospective analysis of 401 Korean patients diagnosed with LN between 1985 and 2019.
- Evaluation of clinical, laboratory indices, treatment response, and final estimated glomerular filtration rate (eGFR).
- Categorization of final renal function based on CKD stages; multivariate Cox proportional hazards analysis for mortality predictors.
Main Results:
- Final renal function was an independent predictor of mortality in LN patients.
- Infection and SLE flare were the primary causes of death.
- SLE flares caused mortality even in patients with end-stage renal disease (ESRD); kidney transplantation (KT) showed a low mortality rate (2/25).
- Overall mortality rates were 6.8% (5 yrs), 10.3% (10 yrs), 19.7% (20 yrs), and 28.0% (30 yrs).
Conclusions:
- Renal function decline is a significant determinant of mortality in Korean LN patients.
- SLE flares can precipitate death in dialysis-dependent LN patients, highlighting the importance of lupus activity control.
- Kidney transplantation may offer benefits for lupus activity and survival in LN patients.
Objective:
To evaluate the predictors of mortality, mortality rate, and causes of death in patients with lupus nephritis (LN) depending on final renal function.
Methods:
The cohort included 401 Korean patients diagnosed with LN between 1985 and 2019. We retrospectively analyzed the clinical and laboratory indices, treatment response, and the final renal function. The final renal function was defined by the last stable level of eGFR measured in an out-patient department more than 3 times before death occurred and was categorized into five groups depending on CKD stage.
Results:
The median follow-up time after the diagnosis of LN was 131 months. No difference in baseline demographic characteristics and laboratory findings was found except for the proportion of Hb less than 10 mg/dl and baseline eGFR (p = 0.011 and 0.037). We found no significant differences in therapeutic parameters, but all the response parameters including treatment response at 6 months (p = 0.004) and 12 months (p = 0.004), time to remission (p < 0.001), final renal response (p < 0.001), and the final renal function (p < 0.001) differed significantly between the two groups. In multivariate Cox proportional hazards analysis, the final renal function was an independent risk factor predicting mortality. The main causes of death were infection and SLE flare. Contrary to existing knowledge, SLE flare also triggered mortality in a few patients with LN progressed to end-stage renal disease (ESRD). Only two cases of mortality occurred in the kidney transplantation (KT) group (n = 25) with a median follow-up period of 224 months. The overall mortality rates calculated using the Kaplan-Meier method were 6.8%, 10.3%, 19.7%, and 28.0% at 5, 10, 20, and 30 years, respectively.
Conclusion:
Renal function deterioration was an independent determinant of mortality in Korean patients with LN. SLE flare also caused mortality in patients with LN who required maintenance dialysis, suggesting the benefit of KT on lupus activity and survival.
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